May 2015
A cinnamon and benzoate free diet for orofacial granulomatosis:
Orofacial granulomatosis (OFG) is a condition which affects mainly the mouth and lips.
Swelling and redness are the most common symptoms but other symptoms such as
mouth ulcers and cracked lips can occur too.
The cause is not known but a cinnamon and benzoate free diet helps 70% of people
with OFG.
Avoiding foods which contain cinnamon and benzoates may help your oral symptoms.
You should try and follow this diet for 12 weeks and monitor any improvements in your
symptoms diary.
Keep to fresh or home cooked food where possible.
If you are unsure whether a food or drink may contain cinnamon or benzoate, it is best
to avoid it.
It is important that you read the labels of any manufactured or prepared foods you
consume.
1
Page 2 of 13
Cinnamon
Cinnamon is a natural substance, which because it is used in very small quantities
does not always have to be stated on food labels. Look for the word spices, spice
extracts, ground cinnamon, mixed spice, cinnamon oil, cinnamal or cinnamic
aldehyde on food labels.
Benzoates
Most benzoates are added to food and drinks as a preservative. They are commonly
added to fizzy drinks and processed foods. High levels of benzoates may also occur
naturally in certain foods. Benzoates includes any of these preservatives:
E210 or Benzoic acid
E211 or Sodium benzoate
E212 or Potassium benzoate
E213 or Calcium benzoate
E214 or Ethyl 4-hydroxybenzoate or Ethyl para-hydroxybenzoate
E215 or Ethyl 4-hydroxybenzoate, sodium salt or sodium ethyl para-hydroxybenzoate
*E216 or Propyl 4-hydroxybenzoate or Propyl para-hydroxybenzoate
*E217 or Propyl 4-hydroxybenzoate, sodium salt or sodium para-hydroxybenzoate
E218 or Methyl 4-hydroxybenzoate or Methyl para-hydroxybenzoate
E219 or Methyl 4-hydroxybenzoate, sodium salt or sodium methyl-hydroxybenzoate
*banned in foods produced within the European Union but may be found in imported
products.
Flavourings
These are chemicals that can be added to many processed foods to improve the
flavour. They are often added to biscuits, crisps, sweets, chutneys, sauces, soft drinks,
soups, ready meals and many more. Some flavourings are compounds related to
cinnamon and benzoates. European law does not require labels to specify the
chemicals used but does require use of the term "flavouring". As it is not possible to
identify the compound added, it is recommended that products labelled with
"flavourings" or "natural flavourings" be avoided where possible.
Food and drink directory
The following pages provide lists of foods that commonly contain cinnamon and
benzoates. This list is correct at the time the information was collected, HOWEVER,
manufacturers may change ingredients from time to time, and you should therefore ensure
that your diet sheet is current and check the list of ingredients on the package label.
Page 3 of 13
Foods Allowed
Foods to avoid
Foods with naturally
occurring benzoates
Foods with added
cinnamon and benzoates
Meat:
Any plain fresh or frozen
meat, meat dishes without
spices or benzoates
Meat in a spicy sauce, cold
meat containing spices,
any made up meat dishes
or pie and pastry fillings
containing spices or
benzoates
Fish:
Any plain fresh or frozen
fish and fish dishes without
spices and benzoates
Fish in a spicy sauce, any
made up fish dishes
containing spices. (N.B. Be
aware of over the counter
delicatessen fish products
with no labels as benzoates
can be added)
Fats and Oils:
Pure butter, shortening.
Pure vegetable oils, lard
and dripping. Margarine,
homemade salad
dressings.
Ready prepared salad
dressings with restricted
ingredients.
Eggs and Dairy Produce:
All types of milk, cream,
sour cream and fromage
frais. Cheese, ice-cream
made with allowed
ingredients. Eggs.
Yogurts with added
cinnamon or fruits rich in
natural benzoates.
Cheeses with spices. Blue
and gorgonzola cheese.
Cereals, rice and pasta;
Bread, rice, pasta, flour,
sago, tapioca, oats (e.g.
porridge) custard powder
and cornflour. Cracker
breads, water biscuits,
cream crackers, original
ryvita, oat cakes, bread
sticks, and rice cakes.
Breakfast cereals without
added cinnamon, dried
fruits and chocolate.
Baked beans, tinned
spaghetti, ravioli and
spaghetti hoops with
spices. Look at labels
carefully on packaged
pasta dishes.
Cakes and biscuits:
Any plain fresh bread,
buns, pizza dough. Any
home-made or
manufactured cakes or
biscuits with allowed
ingredients.
Any manufactured cakes
containing spices. Fruit
cake, carrot cake,
gingerbread, apple strudel,
mince pies, garibaldi,
ginger biscuits are likely to
contain cinnamon.
Page 4 of 13
Foods allowed
Fruit and vegetables
All fresh and frozen fruits or
vegetables not listed on the
right. Examples of fruit
include: apples, oranges,
pears, bananas, satsumas,
tangerines, melon,
pineapple, grapefruit,
lemon, lime, grapes,
mangos. Examples of
vegetables include: broccoli,
cauliflower, cabbage,
carrots, green beans,
runner beans, broad beans
spring greens, lettuce,
cucumber, onion, garlic,
peppers, bean sprouts,
rhubarb
Foods to avoid
Foods with naturally
occurrin• benzoates
Foods with added
cinnamon and benzoates
Dried fruit, fruit sauce.
Avocado, pumpkin, kidney
beans, soy beans', spinach,
berries e.g. blackberries,
cranberries, blueberries,
strawberries, raspberries,
prunes, peaches, papaya,
nectarines
Tomato puree 2 & sundried
tomatoes
Jams and marmalades, fruit
sauces e.g. toppings, tins or
jars of fruit or fruit puree,
glace fruit
Crisps, savoury snacks and nuts
Plain nuts, seeds and plain
or ready salted crisps
without spices.
Sweets and chocolates3
All sweets, chewing gum
with allowed ingredients,
sugar, honey, ginger, apple
and pear preserves, lemon
curd, molasses, maple
syrup, corn syrup and icing
sugar. All other artificial
sweeteners.
Dry roasted nuts, Bombay
mix, spicy nuts or flavoured
crisps.
Cocoa, cinnamon sticks
Chocolate and chocolate
products, cake decorations.
Cola cubes, cola chewits
etc. Liquid artificial
sweetener e.g. Sweetex
liquid.
Soy is often used as a flour alongside wheat flour in breads. The quantities used are very small and so it is
unlikely that this source of soy will cause a reaction. (There are breads available that do not contain soy flour
although these are often more difficult to find).
Soy (Soya) Labelling; The food industry is required by law to highlight ingredients which are common allergens in
their products. This includes ingredients used in other food products prepared in the same environment which
could be potential contaminants. Soy (or soya) is one of these allergens and would usually be prefixed with the
words "may contain". This would mean that soy would only be found in trace amounts (if at all) in foods labelled in
this way. These potential traces would be unlikely to cause a reaction in OFG.
Soya Lecithin is mainly found in very small quantities in margarines, and is unlikely to cause a reaction in OFG. It
is possible however to find alternatives without soya lecithin.
Tomato puree is tomato concentrate. Benzoic acid is found naturally at very low levels in tomatoes. Tomatoes
do not need to be avoided but due to the higher concentration of tomatoes in tomato puree, levels of benzoic acid
will be higher and should potentially be avoided in large quantities. Sundried tomatoes may be more concentrated
sources of benzoic acid if used in large quantities.
2
3
Chocolate can often cause a reaction and is usually best avoided in OFG for at least 12 weeks.
Page 5 of 13
Foods allowed:
Foods to avoid:
Foods with naturally
occurring benzoates
Foods with added
cinnamon and benzoates
Miscellaneous:
Pickles or sauces with
allowed ingredients.
Lemon curd, peanut butter,
vegemite.
Pickles and pickled
products e.g. herring,
beetroot, ketchup, soy
sauce, deli products,
marmite,
Check sauces
Herbs and Spices:
Salt, pepper, herbs e.g.
basil, chives, mint, thyme,
oregano, rosemary, single
spices e.g. chilli, ginger,
cumin, coriander seed,
turmeric.
Cinnamon sticks, cinnamon
powder, cloves, nutmeg,
sage, curry powder, all
spice, mixed spice, cassia,
garam masala.
Drinks:
All drinks with allowed
ingredients e.g.
unflavoured still and
carbonated water. Fruit
juices
Fruit juices made with
fruits containing natural
benzoates (e.g. berries,
strawberries, raspberries,
prunes, peaches, papaya,
nectarines)
Coffee, fruit and herbal
infusions.
Tea including black tea,
green tea, rooibos tea.
Alcohol, lager beer, white
wine, red wine, cider,
whiskey.
Some fizzy drinks e.g. cola
drinks, Vimto, Dr Pepper,
Fanta, Irn Bru, Sprite.
Flavoured bottled waters.
Squash, cordial, glucose
drinks e.g. Lucozade. Milk
shake syrups, flavoured
milk, Slush Puppie, nonalcoholic grape drinks,
liquid coffee and chicory
drinks, e.g. Camp
Alcohol: Gin, red and
white Martini and Cinzano,
perfumed drinks, e.g.
Dubonnet, Malibu, dark
rum, Tia Maria, mulled
wine.
Medicines, vitamins and minerals:
Some tablets contain
benzoates in the white
coating. Check with your
pharmacist.
Toothpaste and mouthwash:
Most toothpaste and
mouthwashes e.g. Colgate
total whitening toothpaste,
Mcleans total health white,
Kingfisher fennel
toothpaste, Corsodyl
mouthwash (mint and
original) Dentyl PH minty
citrus mouthwash.
Some toothpastes and
mouthwashes (read
labels). Avoid those
labelled with benzoates,
“clove oil”,
“aroma and cinnamal”
Page 5 of 13
Foods allowed:
Foods to avoid:
Foods with naturally
occurring benzoates
Foods with added
cinnamon and benzoates
Miscellaneous:
Pickles or sauces with
allowed ingredients.
Lemon curd, peanut butter,
vegemite.
Pickles and pickled
products e.g. herring,
beetroot, ketchup, soy
sauce, deli products,
marmite,
Check sauces
Herbs and Spices:
Salt, pepper, herbs e.g.
basil, chives, mint, thyme,
oregano, rosemary, single
spices e.g. chilli, ginger,
cumin, coriander seed,
turmeric.
Cinnamon sticks, cinnamon
powder, cloves, nutmeg,
sage, curry powder, all
spice, mixed spice, cassia,
garam masala.
Drinks:
All drinks with allowed
ingredients e.g.
unflavoured still and
carbonated water. Fruit
juices
Fruit juices made with
fruits containing natural
benzoates (e.g. berries,
strawberries, raspberries,
prunes, peaches, papaya,
nectarines)
Coffee, fruit and herbal
infusions.
Tea including black tea,
green tea, rooibos tea.
Alcohol, lager beer, white
wine, red wine, cider,
whiskey.
Some fizzy drinks e.g. cola
drinks, Vimto, Dr Pepper,
Fanta, Irn Bru, Sprite.
Flavoured bottled waters.
Squash, cordial, glucose
drinks e.g. Lucozade. Milk
shake syrups, flavoured
milk, Slush Puppie, nonalcoholic grape drinks,
liquid coffee and chicory
drinks, e.g. Camp
Alcohol: Gin, red and
white Martini and Cinzano,
perfumed drinks, e.g.
Dubonnet, Malibu, dark
rum, Tia Maria, mulled
wine.
Medicines, vitamins and minerals:
Some tablets contain
benzoates in the white
coating. Check with your
pharmacist.
Toothpaste and mouthwash:
Most toothpaste and
mouthwashes e.g. Colgate
total whitening toothpaste,
Mcleans total health white,
Kingfisher fennel
toothpaste, Corsodyl
mouthwash (mint and
original) Dentyl PH minty
citrus mouthwash.
Some toothpastes and
mouthwashes (read
labels). Avoid those
labelled with benzoates,
“clove oil”,
“aroma and cinnamal”
Page 6 of 13
Sample meal plan
Breakfast
Cereal (e.g. Cornflakes, Weetabix, Shreddies) with milk and/or
Bread with butter and honey or lemon curd or peanut butter or vegemite and/or
Natural yoghurt or fromage frais with honey and fresh fruit (e.g. banana, apple, pear etc)
Coffee or fruit/herbal infusion
Fresh orange/grapefruit juice
Mid morning
Coffee or fruit/herbal infusion
Tea biscuits or suitable fruit
Snack meal
Sandwich with butter, cold meat or fish (e.g. chicken, salmon, tuna, beef, lamb, ham) or cheddar
cheese or egg or peanut butter or vegemite or houmous and salad and/or Jacket potato with
cheddar cheese or tuna and sweetcorn and salad
Yoghurt and suitable fresh fruit
Water or orange/grapefruit juice diluted with water
Mid afternoon
Coffee or fruit/herbal infusion
Cake or biscuits (see manufactures list) or suitable fruit
Main meal
Starters:
Soup (made from allowed ingredients) or melon or grapefruit
Main course:
Meat or poultry or fish with vegetables e.g. carrots, peas and mashed potatoes with butter and
milk and gravy (see basic recipes) or
Pasta with fresh pesto sauce or other suitable sauce and salad or vegetables or Rice
with meat or poultry or fish in suitable sauce and salad or vegetables
Puddings:
Rice pudding
Yoghurt and fruit
Custard and tinned fruit Ice cream
Water or orange/grapefruit juice diluted with water
Supper
Cheddar cheese on toast or
Toast and butter or margarine with honey or lemon curd or peanut butter
Coffee or fruit/herbal infusion
Milk
Page 7 of 13
Eating out:
Eating out is often the biggest challenge as cross contamination with cinnamon
and not knowing exact ingredients can make this difficult. Be aware of certain
ingredients like pickles and sauces from an unknown origin. Preserved and
processed meats, and fish or those with added spices and cheese with spices or
blue veins need to be avoided. Cakes and pastries that are unpackaged and sold
as individual items are more likely to be contaminated with cinnamon (e.g. those
sold in coffee shops and bakeries or patisseries).
Snack or light meals:
It may be possible to read ingredients on pre-packaged foods. If not then
sandwiches, salads and jacket potatoes can be a good alternative.
Choose plain fillings e.g. chicken, beef, pork, lamb, tuna, salmon,
prawns, Cheddar cheese with salad.
It may be possible to include some of the ingredients (such as mayonnaise,
houmous, yoghurt) if you can read the labels.
Snack on suitable fruit and vegetables.
Restaurants:
Try to avoid restaurants that would use cinnamon and other spices as part
of their regular cuisine. The risk of cross contamination is quite high even
if you order food without added spice. These might include, Indian, Thai
and Chinese restaurants. Use of cinnamon, curry powder and soy sauce
are key ingredients in Asian cooking and a high concentration of spices
are more likely to cause a reaction.
A greater selection of food choice might be found in Italian, French, British,
European and American restaurants. Ask the staff about the food and
check it is free from spices (particularly if you are ordering foods that may
contain sauces).
Possible options:
Be cautious and ask for further
information from restaurant:
Garlic bread
Olives
Breaded garlic mushrooms
Cured meats, avocado, tomato puree,
marinades, sauces, sun-dried
tomatoes.
Most plain meats, calves liver, steak,
fish, shellfish.
Pizza (usually tomato base spread
thin) check with suitable toppings.
Pasta with cream sauce or soured
cream or pesto or olive oil and
allowed vegetables. Salads
Freshly made burgers (check
ingredients) with salad and chips.
Omelette
NB Fresh nutmeg is traditionally used
in béchamel sauces, rice puddings
and is sometimes added to baked or
stewed fruits, sauces, soups.
Suitable fruit with cream or yogurt
Always ask about cooked puddings
and ice-cream as cinnamon and
nutmeg are often used.
Page 8 of 13
Basic Recipes:
The following recipes are to help you avoid frequently used gravies and dressings that
often contain benzoates or spices.
Traditional gravy from roast meat:
Ingredients:
1 tablespoon of flour
1 pint of stock (used cooked vegetable water or allowed stock powders or cubes)
Remove the cooked meat from the roasting tin leaving the juices of the meat in the tin.
Tilt the tin and with a metal spoon remove the most of the fat (leave approx. 1 – 2
spoons). With a wooden spoon, scrape the tin to release the extracts (and flavour) of
the cooked meat. Put the tin over a low heat and it should start to simmer. At this
point, add a tablespoon of flour and stir vigorously with the wooden spoon. You are
aiming for a smooth paste. Add approx. 500ml water from cooked vegetables to provide
liquid. Allow the gravy to boil and then reduce over a gentle heat to your preferred
consistency. For paler meats, you can add some onion and let them caramelise a little
before adding the flour or you can add a little gravy browning.
Meatless onion gravy:
Ingredients:
3 large sliced onions
2 crushed garlic cloves
1 tablespoon brown sugar
75g flour
75ml gravy browning
500ml stock (use cooked vegetable water or allowed stock powders or cubes)
Salt and pepper
Oil for frying the onions
In a saucepan, fry the onions, garlic and sugar until they are golden brown and
caramelised. Sprinkle in the flour and mix together. Stir in a small amount of stock and
mix to a smooth paste. Add the rest of the stock and boil. Reduce over a gentle heat to
your preferred consistency.
Vinaigrette:
Ingredients:
100ml olive oil
50mls white wine vinegar
1 crushed clove of garlic (or a small blob of garlic puree)
1 teaspoon mustard if desired
Salt and pepper
Put all the ingredients in a sealed container (e.g. a jam jar with a tight lid). Shake
vigorously.
Page 9 of 13
Spicy food is often avoided on a cinnamon and benzoate free diet in case the spices used
include cinnamon or other spices that may be high in naturally occurring benzoates such
as cloves or nutmeg. It is possible to have spicy food but requires a little more thought.
Below is an example of a curry paste that you can make and add to meat, fish and
vegetables to make a curry.
Curry paste Ingredients:
1 inch of ginger — peeled and chopped
1 green or red chilli (all provide different strengths of heat and flavour so experiment.
Remove the seeds unless you want a very hot curry paste)
3 fat cloves of garlic crushed
1 teaspoon coriander powder
1 teaspoon cumin powder
/2 teaspoon turmeric powder
(ideally if you buy the seeds there will be less chance of contamination from cinnamon and
cassia, which would normally be manufactured in the same location) — to prepare seeds, lightly
toast and grind in a pestle and mortar or a coffee grinder to a powder.
Add a little water or oil
1
Instructions:
Mix all of the above ingredients together — you are aiming for a puree consistency (you can
also buy readymade ginger and garlic purees which might be easier)
How to serve:
This paste can be the basis of many curry dishes. You simply need to add a few teaspoons to a
vegetable or meat/fish dish. Meat or vegetables can be marinated in this to provide it with
flovour and can then be cooked. Alternatively to make a curry with a
sauce, you can add fresh chopped tomatoes, natural yoghurt or cream. Coconut is often
used in curries and coconut milk, cream or desiccated can be used to add extra flavour to
your curry.
Page 10 of 13
Snacks on a cinnamon and benzoate free diet
Some snacks can contain added spices and initially it can seem difficult to know what have
when you are following a cinnamon and benzoate free diet. Below are some ideas to help
you with this. N.B. some of the following foods can have flavourings added so always
check your labels.
Savoury snacks
Prawn crackers
Rice cakes
Popcorn
Plain or salted crisps or nuts
Plain crackers and water biscuits
Cracker breads
Taramasalata, hummus and tzatziki (check labels)
Vegetable sticks (e.g. cucumber, peppers, carrots)
Cheese (e.g. such as cheddar, Wensleydale, goats cheese, Edam, Brie, Camembert)
Olives
Plain croissants and butter
Crumpets with butter (and/or marmalade, lemon curd, honey, peanut butter or other
allowed preserves)
Muffins with melted cheese
Toast with butter or peanut butter or cheese (and/or marmalade, lemon curd, honey or
other allowed preserves)
Sweet snacks
Meringues (mix with double cream and lemon curd or ginger preserve for an easy
pudding)
Plain yoghurt (add some allowed fruit e.g. banana, kiwi, apple, pear etc or lemon curd,
honey, ginger preserve)
Plain scones and butter (and allowed preserves e.g. pear, ginger, apple preserve, honey,
lemon curd)
Sweet waffles
Crumpets with butter
Muffins with melted cheese
Tea biscuits, ginger nut biscuits, short bread biscuits, digestive biscuits
Page 11 of 13
Cosmetics, toiletries and hygiene products
Most hygiene products and cosmetics contain derivatives of cinnamon and benzoates.
Cinnamon and benzoates may be added to cosmetics as preservatives or perfume agents.
It is not clear if cinnamon and benzoates added to cosmetics contribute or exacerbate
symptoms in OFG but there is some evidence that they can be absorbed through the skin.
For this reason we advise wherever possible that you try and find products free from
cinnamon and benzoates particularly ones you would use directly on your face such as
face creams, lip balms,•make up and sunscreens.
Cinnamon and benzoate free products can be difficult to find and manufacturers can
change the ingredients they use at any time making it difficult to provide up-to-date
information on suitable hygiene products and cosmetics. Some may contain cinnamon or
cinnamon derivatives so it is always important to check the ingredients before you buy and
use a product.
Ingredients to check include:
Benzoic acid
Sodium benzoate
Potassium benzoate
Benzyl alcohol
Ethylhexyl methoxycinnamate
Parfum, benzyl benzoate
Cinnemaldehyde
Amyl cinnemaldehyde
Amyl cinnamyl alcohol
Amyl cinnamyl acetate
Benzyl cinnamate
Cinnamyl cinnamate
Parabens: Methyparaben, ethylparaben, propylparaben and butylparaben
Please note this list is not exhaustive as derivatives for cinnamon and benzoates are
extensive but it does provide a rough guide.
Page 12 of 13
Below are 10 tips to help you select and use suitable products:
1. Wherever possible (although often difficult) try to minimise your use of products with
fragrance as "parfum" can contain cinnamon or cinnamon derivatives to which you
may be sensitive.
2. Baby products are sometimes free from fragrances. Baby products often contain
minimal preservatives and additives so it may help to use these rather than normal
versions.
3. Lip balms can grow germs which may exacerbate symptoms or increase your risk of
infection particularly if your lips are cracked or prone to bleeding. If you are using a
stick you can clean it with a little tissue before and after application. When using lip
balms or lip sticks, replace them regularly and apply with clean hands.
4. Mineral make-ups are often free from cinnamon and benzoates and are useful
when looking for suitable make-up products.
5. Health food shops and manufacturers specialising in "organic" or "natural" products
are often useful for finding suitable products. You will still need to check the
ingredients as the majority will contain added cinnamon, cinnamon derivatives and
benzoates.
6. Cinnamon and benzoate free sunscreens can be very difficult to find in high street
shops. It is best to be prepared and purchase these products before going on
holiday or being exposed to the sun.
7. Crystal mineral deodorants are free from cinnamon and benzoates and are often
stocked in High Street chemists.
8. Parabens (methylparaben, ethylparaben, propylparaben and butylparaben) are
derivatives of benzoates that can be used in foods and cosmetics. Products will
often state if they are free from parabens which can be helpful but check that there
are not other ingredients that are cinnamon and benzoate derivatives.
9. If you are going to use a new product that is going to be used on your face or lips
and are worried that it might cause a reaction, try it first on a small area to assess
your response. Try a small amount of the product on one part of your lips or face
and only use this part for the assessment. Do this for a minimum of 4 days before
using the product freely. Before starting anything new it is best to be symptom free
or at least have stable OFG (i.e. you are not having a flare up). Do not make any
other dietary or cosmetic changes whilst undertaking this assessment.
10.When reading labels, ingredients are listed in order of quantity. The lower down the
ingredient list a compound is the less of it there is in that product.
Page 13
Notes: